Provider Demographics
NPI:1336294685
Name:MEDICAL EDGE HEALTHCARE GROUP PA
Entity Type:Organization
Organization Name:MEDICAL EDGE HEALTHCARE GROUP PA
Other - Org Name:BENCHMARK FAMILY OF MEDICINE OF ROWLETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEIGHTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-739-3001
Mailing Address - Street 1:9229 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:972-739-3637
Mailing Address - Fax:972-739-2673
Practice Address - Street 1:5501 GORDON SMITH DR
Practice Address - Street 2:SUITE 500
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-3937
Practice Address - Country:US
Practice Address - Phone:214-703-8100
Practice Address - Fax:214-703-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare ID - Type Unspecified